Understanding the patellofemoral joint in total knee arthroplasty.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: J. Matz declares no competing interests. B. Lanting declares ownership of IdealFit Spacer Solutions, paid consultancies with Intellijoint Surgical, Stryker and DePuy Synthes, and research grants from Stryker, DePuy Synthes and Smith & Nephew. J. Howard declares ownership of PersaFix Technologies, paid consultancies with DePuy Synthes, Stryker, Smith & Nephew and Intellijoint Surgical, and institutional research support from DePuy Synthes, Smith & Nephew, Stryker, Zimmer Biomet and MicroPort. 12. Am J Orthop (Belle Mead NJ). 2016 May-Jun;45(4):E153-60. The Cruciate Ligaments in Total Knee Arthroplasty. Parcells BW, Tria AJ Jr(1). Author information: (1)The Orthopaedic Center of New Jersey, Somerset, NJ. atriajrmd@aol.com. The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction.